Clinical outcomes and mortality associated with weekend admission to psychiatric hospital: implications for provision of 7 day mental health care in the National Health Service

TY - JOUR

T1 - Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

T2 - implications for provision of 7 day mental health care in the National Health Service

AU - Patel, Rashmi

AU - Chesney, Edward

AU - Cullen, Alexis

AU - Tulloch, Alexander David

AU - Broadbent, Matthew

AU - Stewart, Robert James

AU - McGuire, Philip

PY - 2016/2/25

Y1 - 2016/2/25

N2 - Background Previous studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. Thus, there is a drive to move towards provision of a 7 day health-care service in the UK. However, less is known about variations in clinical outcomes among patients admitted to psychiatric hospitals. We sought to investigate variations in clinical outcomes for patients admitted to a psychiatric hospital at the weekend. Methods The study was conducted with anonymised electronic health record data from the South London and Maudsley NHS Foundation Trust. Data were obtained from all consecutive admissions to psychiatric hospitals within the Trust between April 1, 2006, and March 31, 2015, with the Clinical Record Interactive Search tool. The association of weekend or bank holiday admission with duration of admission, risk of readmission, and inpatient mortality were investigated by multivariable regression analyses with age, sex, and ethnicity as covariates. Secondary analyses were performed to investigate the distribution of admissions, discharges, inpatient mortality, episodes of seclusion, and violent incidents on different days of the week. Findings 7303 (16·1%) of 45 264 admissions commenced during a weekend or bank holiday. Patients who were aged between 26 and 35 years, female, or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals, or the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (β coefficient −21·1 days, 95% CI −24·6 to −17·6; p<0·001) and increased risk of readmission in the 12 months after index admission (incidence rate ratio 1·13, 1·08–1·18; p<0·001) but no significant difference in inpatient mortality (odds ratio 0·79, 0·51–1·23) compared with weekday admission. Fewer episodes of seclusion occurred at the weekend (χ2=15·8, p=0·02) but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. Interpretation We show that patients admitted at the weekend had shorter admissions and increased risk of readmission but no significant difference in risk of inpatient mortality compared with those admitted during the week. This finding contrasts with previous studies in acute hospitals where weekend admission is typically associated with increased likelihood of inpatient mortality, and highlights a need to consider variations in demand when implementing health-care services across a 7 day week. Funding National Institute for Health Research, Medical Research Council.

AB - Background Previous studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. Thus, there is a drive to move towards provision of a 7 day health-care service in the UK. However, less is known about variations in clinical outcomes among patients admitted to psychiatric hospitals. We sought to investigate variations in clinical outcomes for patients admitted to a psychiatric hospital at the weekend. Methods The study was conducted with anonymised electronic health record data from the South London and Maudsley NHS Foundation Trust. Data were obtained from all consecutive admissions to psychiatric hospitals within the Trust between April 1, 2006, and March 31, 2015, with the Clinical Record Interactive Search tool. The association of weekend or bank holiday admission with duration of admission, risk of readmission, and inpatient mortality were investigated by multivariable regression analyses with age, sex, and ethnicity as covariates. Secondary analyses were performed to investigate the distribution of admissions, discharges, inpatient mortality, episodes of seclusion, and violent incidents on different days of the week. Findings 7303 (16·1%) of 45 264 admissions commenced during a weekend or bank holiday. Patients who were aged between 26 and 35 years, female, or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals, or the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (β coefficient −21·1 days, 95% CI −24·6 to −17·6; p<0·001) and increased risk of readmission in the 12 months after index admission (incidence rate ratio 1·13, 1·08–1·18; p<0·001) but no significant difference in inpatient mortality (odds ratio 0·79, 0·51–1·23) compared with weekday admission. Fewer episodes of seclusion occurred at the weekend (χ2=15·8, p=0·02) but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. Interpretation We show that patients admitted at the weekend had shorter admissions and increased risk of readmission but no significant difference in risk of inpatient mortality compared with those admitted during the week. This finding contrasts with previous studies in acute hospitals where weekend admission is typically associated with increased likelihood of inpatient mortality, and highlights a need to consider variations in demand when implementing health-care services across a 7 day week. Funding National Institute for Health Research, Medical Research Council.

U2 - 10.1016/S0140-6736(16)00466-9

DO - 10.1016/S0140-6736(16)00466-9

M3 - Meeting abstract

SN - 0140-6736

VL - 387

SP - S79

JO - The Lancet

JF - The Lancet

IS - Supplement 1

M1 - S0140-6736(16)00466-9

ER -